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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426760
Report Date: 01/18/2022
Date Signed: 01/18/2022 01:05:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CITRUS COURTFACILITY NUMBER:
336426760
ADMINISTRATOR:MARLYA DUNHAMFACILITY TYPE:
740
ADDRESS:161 N HEMET STTELEPHONE:
(951) 927-6817
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:66CENSUS: 33DATE:
01/18/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Marlya Dunham, AdministratorTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jesse Gardner arrived at the facility unannounced for the purpose of investigating a complaint (#18-AS-20220110092445). During LPA Gardner's inspection, LPA Gardner observed a staff member who did not have a background clearance. Below is a summary of what was observed:
  • Criminal Record Clearance - LPA Gardner observed one staff member working at the facility but did not have a clearance to be working. LPA Gardner was able to confirm there was no background clearance obtained for the staff member after review of Guardian (personnel management system), it was determined that Ms. Crowfield did not have a clearance to be working at the facility. Upon interview with Ms. Crowfield, she indicated she had worked inside the facility since approximately December 2, 2021 and works daily. A facility must have submitted their background clearance prior to them working in the facility. Deficiency cited. This deficiency comes with a civil penalty in the amount of $100 per day, for a maximum of 5 days.


LPA observed Ms. Crowfield leave the facility. An exit interview was given to Ms. Dunham along with a copy of this report as well as the LIC811, and 809-D, and Appeal Rights.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CITRUS COURT
FACILITY NUMBER: 336426760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/19/2022
Section Cited

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87355 Criminal Record Clearance
(d) All individuals subject to criminal record review shall be fingerprinted...

(3)The license shall submit these fingerprints to the California Department of Justice...prior to the individual's employment, residence, or initial presence in the facility.
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Licensee did not ensure S1 obtained a criminal record clearance prior to beginning working at facility. Based on record review and interview, S1 had been working at the facility since 12/2/21. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2022
LIC809 (FAS) - (06/04)
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